Treatment With High‐dose Proton Pump Inhibitors Helps Distinguish Eosinophilic Esophagitis From Noneosinophilic Esophagitis

作者：Wael N. Sayej, Raza A. Patel, Robert D. Baker, Eduardo Tron, Susan S. Baker · 发表于：Journal of Pediatric Gastroenterology and Nutrition · 年份：2009 · DOI：10.1097/mpg.0b013e31819c4b3e · 被引用次数：147 · 研究领域：Eosinophilic Esophagitis、Food Allergy and Anaphylaxis Research、Potassium and Related Disorders

BACKGROUND: Eosinophilic esophagitis (EE) is a clinical entity that is recognized increasingly in children. The treatment of EE has been debated since its identification as a clinical entity separate from reflux esophagitis. We hypothesize that the treatment with a high-dose proton pump inhibitor (HDPPI) helps differentiate EE from noneosinophilic esophagitis (NEE). PATIENTS AND METHODS: Retrospective review of 2221 patients who underwent esophagogastroduodenoscopy (EGD) with biopsies was undertaken. Sixty-nine patients had more than or equal to 15 eosinophils/high-power field (eos/HPF) in 1 or more esophageal levels. Of those, 36 were initially treated with HDPPI for 3 months followed by repeat EGD. Patients who demonstrated histologic response were classified as NEE. Patients with no histologic response were diagnosed as having EE and treated with HDPPI+swallowed fluticasone for 3 months followed by repeat EGD. RESULTS: Of the 36 patients, histologic response was seen in 14 (39%) after treatment with HDPPI; 95% confidence interval (0.23-0.54). Swallowed fluticasone was added to the treatment of the 22 patients who did not show histologic response to HDPPI alone. Of those, 15 patients underwent repeat endoscopies. Seven patients were lost to follow-up or did not have repeated EGDs. Histologic response was observed in 9 of 15 (60%) patients. Of the nonresponders (6 of 15), 5 of 6 (83%) self-reported noncompliance with the swallowed fluticasone. Patients with more than or equa...